终末期肾病患者心血管事件与血清胎球蛋白A及冠脉钙化的关系

目的探讨终末期肾病（ESRD）患者心血管事件发生与血清胎球蛋白A及冠脉钙化的关系。方法对38例ESRD初始血液透析患者进行血清胎球蛋白A及相关因素检测，对其中的29例患者进行冠状动脉多层螺旋CT钙化评价研究。所有38例患者随访时间为18个月。22例非ESRD慢性肾脏病（CKDⅡ～Ⅲ期）患者人选对照组。结果38例ESRD初始透析患者在18个月随访期内出现心血管事件30例次，因心血管事件死亡者6例，占15．79％，而非ESRD患者心血管事件仅3例次（P〈0．01）且无一例死亡（P〈0．05）。ESRD血清低胎球蛋白A组心血管事件显著高于ESRD血清高胎球蛋白A组（P〈0．01）。多元逐步回归分析显示，心血管事件与血清胎球蛋白A（P〈0．01）、C反应蛋白（CRP）（P=0．0014）及低密度脂蛋白C（LDL-C）（P=0．008）密切相关。18／29例（62．07％）有冠状动脉钙化。冠状动脉钙化患者心血管事件比无冠状动脉钙化患者显著增多（P〈0．01）。冠脉钙化的ESRD患者血清胎球蛋白A水平较无冠脉钙化的ESRD患者明显下降（P〈0．01）。冠脉钙化与胎球蛋白A下降及高血磷有关（P〈0．01，P〈0．01）。结论ESRD透析患者心血管事件和（或）心血管事件死亡可能与血清胎球蛋白A下降及冠状动脉钙化有关。

Association of cardiovascular events with serum fetuin A and coronary artery calcification in ESRD patients

Objective To investigate the potential contributing effects of reduced serum fetuin A and coronary artery calcification (CAC) on cardiovascular events in end stage renal disease (ESRD) patients. Methods Thirty-eight ESRD patients on chronic hemodialysis (duration of hemodialysis less than 6 months)were enrolled in this study.Controls consisted of 22 non-ESRD patients with chronic kidney diseases (CKD). Serum fetuin A and related parameters, along with CAC score quantified by Multislice Spiral CT scan, were examined at the initiation of this study. The patients were followed up for 18 months for appraising cardiovascular events defined as cardiac failure, angina pectoris or myocardial infarction. Results During the 18 months follow-up, significant difference in cardiovascular events was documented in patients with ESRD (30 times) and without ESRD (3 times,P=0.001). Eighteen cases of CAC(62.07%)were identified by CT scan in 29 ESRD patients. Stepwise regression analysis in 38 ESRD patients without induction of CAC score indicated that fetuin A (P<0.01), LDL-C (P=0.008) and CRP (P=0.014) were independently associated with cardiovascular events. After induction of CAC score, stepwise regression analysis in 29 ESRD patients with CAC showed that fetuin A (P < 0.0005) and CAC score (P=0.006) were associated with cardiovascular events. Serum fetuin A was lower in patients with CAC than that in patients without CAC (P=0.001). Stepwise regression analysis showed that CAC was associated with reduce fetuin A (P< 0.0005) and elevated serum phosphorus (P=0.001). Conclusion Reduced serum fetuin A and coronary artery calcification may contribute to cardiovascular events in ESRD patients receiving hemodialysis.